AntiCoagulation Europe campaigns >

A campaign to increase understanding of thrombosis and stroke prevention

it's about time campaign

it's about time is a new campaign led by AntiCoagulation Europe and a Taskforce of key international physicians and healthcare professionals, which aims to promote greater understanding of thrombosis and stroke prevention and ultimately to help raise standards of care.

On the 31st August 2004, AntiCoagulation Europe and members from the it's about time Taskforce officially launched the campaign with the presentation of results from a new pan-European survey, conducted amongst 711 patients from seven European countries (France, Germany, Italy, Norway, Spain, Sweden and the UK) who are receiving a vitamin K antagonist (VKA) such as warfarin. The survey was designed to gain patients' insights into their treatment and demonstrates a need for improved patient education and less cumbersome treatments to improve outcomes and quality of life amongst patients receiving long-term anticoagulant therapy.

The it's about time survey, by providing patients' insight into their treatment, will complement the Euro Heart Survey on Atrial Fibrillation (AF) - irregular heartbeat - of the European Society of Cardiology (ESC), which is a survey conducted by the ESC amongst cardiologists in 35 countries to identify attitudes towards, and opinions of, the management of anticoagulation in AF. Bringing together the results of these surveys will help to improve understanding of anticoagulation and its management from both a physicians' and patients' viewpoint.

Atrial fibrillation occurs in around one in twenty-five adults over sixty years of age and more than one in ten adults over eighty years old. Patients with AF experience a six-fold increased risk of stroke compared with those with a normal heartbeat and, as a result, across 22 European countries with a combined population of 500 million, there are almost one million strokes each year, making it the second leading cause of death worldwide.

Eve Knight, Chair of AntiCoagulation Europe, commented at the launch of the it's about time survey, 'I am thrilled to be able to officially kick-off the it's about time campaign. With the presentation of this survey data at the annual congress of the ESC in Munich, we are embarking on an exciting and extremely important journey to help increase understanding of the problems with existing anticoagulation therapy, and the urgent need for improvements in its management.'
 

Results from the it's about time patient survey

The survey, conducted amongst patients with AF - which results in a six-fold increase risk of stroke - highlights the impact that problems with VKAs have on patients' lives.

Although effective at preventing blood clots and stroke, VKAs are associated with extensive food and drug interactions and require careful management and regular coagulation monitoring to ensure the balance between efficacy and safety is achieved.

The impact of life-long coagulation monitoring

Of patients questioned in the it's about time survey, 66% reported having to attend blood-monitoring sessions, typically at a hospital or clinic, at least once a month for the entire duration they had received therapy - which had been an average of six years, with one in ten patients having received treatment for fifteen years or longer. Patients also reported that their monitoring had a negative impact on their ability to hold down a job, go on holiday and spend time with their families.

In response to INR fluctuations, patients needed dose changes following every fourth monitoring session, on average. Unsurprisingly, one in six patients have missed, or forgotten to begin, their new regime.

In part, this may also be explained by the finding that over a third of patients believed their being 'out of range' with their INR had no major effect on their health.

Food and drug interactions

Whilst a quarter of patients reported taking over-the-counter or herbal medicines in addition to their prescription drugs, only a third have informed their doctor of this - placing themselves at risk of negative VKA drug interaction and ineffective protection from stroke. The survey also found that almost half of patients questioned had modified their diet to avoid food interactions with VKAs.

Patient self-management and INR monitoring

Despite the crucial role patients are required to play in managing their own treatment, the survey highlights a dangerous lack of patient education. Only 25% of those questioned on their anticoagulant treatment responded that their medication was used to prevent blood clots occurring. One in seven AF patients incorrectly thought that VKAs are used to correct their irregular heartbeat.

It is known that compliance is reliant on the patient's understanding of their condition. However, without the proper information or guidance, patient compliance can suffer, leaving them at risk of bleeding or stroke.

The it's about time survey highlights this:

A quarter of patients did not remember receiving any information on AF at their time of diagnosis

Only one in three patients recalled being provided with information about their treatment at the time of their diagnosis

24% of patients felt they could have been given further useful information when diagnosed with AF

Over a third of patients felt that their doctor could have told them more regarding their medication and how it would affect their lifestyle

The survey also shows that whilst 62% of patients are aware that an INR reading that is too high or too low may effect their health, it remains the case that:

Just under three-quarters of patients know what their target INR reading is

Only 3 in every 10 patients claim to have met their target in all of their last 5-10 monitoring sessions

7% of patients had missed their INR target in all of their last 5-10 monitoring sessions

'Without an understanding of what the drug does and how everyday actions can affect its efficacy, patients may unwittingly undermine the protection VKAs provide against stroke,' comments Eve Knight. 'it's about time will bring together physicians and patient groups to urge for improved education and new treatment options to improve clinical outcomes and quality of life for patients receiving long-term anticoagulation.'

The next stage for the it's about time campaign will be an in-depth debate of the results of both the it's about time survey and the Euro Heart Survey on Atrial Fibrillation of the ESC. 'The ESC is committed to improving standards of care for patients with AF and the Euro Heart Survey on Atrial Fibrillation will assist by identifying and sharing best practice,' commented Professor Harry Crijns, Department of Cardiology, University Hospital of Maastricht and lead investigator, Euro Heart Survey on Atrial Fibrillation. 'We welcome the it's about time campaign and the findings of the patient survey, which will help to raise discussion to ensure that patients on long-term anticoagulation are receiving the best care possible.'

The planned debate will be led by AntiCoagulation Europe and members of the it's about time Taskforce, but will also seek the input of key stakeholders from the medical community, patients and thrombosis advocacy groups. Conclusions and a 'call to action' from the debate are due to be published in a report in early 2005.

The it's about time patient survey is sponsored by an unrestricted educational grant from AstraZeneca.

Members of the it's about time Taskforce

Professor Giancarlo Agnelli Professor of Internal Medicine, University of Perugia, Perugia, Italy

Professor Gregory YH Lip Consultant Cardiologist, Honorary Professor of Cardiovascular Medicine, Director - Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

Professor Giles Montalescot Institute of Cardiology, Hôpital Pitié Salpétrière, Institut du Coeur, Paris, France

Dr Dan Rost General Practitioner, Præstegårdsvej 5, DK-6070 Christiansfeld, Denmark